Provider Demographics
NPI:1528000734
Name:PATEL, MRUNAL CHAMPAKBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MRUNAL
Middle Name:CHAMPAKBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4861
Mailing Address - Country:US
Mailing Address - Phone:432-697-1000
Mailing Address - Fax:432-697-6000
Practice Address - Street 1:4214 ANDREWS HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4861
Practice Address - Country:US
Practice Address - Phone:432-697-1000
Practice Address - Fax:432-697-6000
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2555207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103605501/080363701Medicaid
TX83461K / 00320KMedicare ID - Type UnspecifiedINDIVIDUAL & GROUP ID
TXG47828Medicare UPIN